Severely resorbed mandible: Predictable reconstruction with soft tissue matrix expansion (tent pole) grafts

Abstract

Purpose: Attempts to reconstruct the severely resorbed mandible (≤6 mm) have historically been unsuccessful and often been complicated by fracture, fistulas, and neurosensory loss. In the past, bone grafts to these severely resorbed mandibles have rapidly resorbed due to a soft tissue volume deficiency that contracts about the graft. Material and Methods: A novel surgical approach using dental implants as “tent poles,” along with bone grafting, is described, and the long-term follow-up of 64 cases is presented. Results: The results revealed that all 64 grafts maintained 15 mm of bone height, with a follow-up ranging from 3 to 10 years and a mean follow-up of 4.9 years. The starting bone heights ranged from 3 to 6 mm, with a mean height of 4.8 mm. The mean bone height gain was 10.2 mm, with a range of 9 to 13 mm. All patients progressed to a functional denture that remained in function at the time of their follow-up. Short-term parasthesia (≤3 weeks) was noted in 17.1% of patients, but no permanent neurosensory disturbance was noted. In these 64 cases, 356 dental implants were placed and 354 were osseointegrated (99.5%) and functioning at the time of follow-up (≥3 years). Conclusions: The novel strategy of this surgery whereby bone grafts consolidate and maintain their volume by dental implants that creates a tenting effect offers predictable long-term reconstruction of the severely resorbed mandible without the complications observed with other approaches. © 2002 American Association of Oral and Maxillofacial Surgeons J Oral Maxillofac Surg 60:878-889, 2002